Dental Water Jet By: Jennifer Buffington, Lindsay Hunt, Ruth Gardner
What is a Dental Water Jet? A home, dental self-care device that uses a stream of pulsating water to irrigate the subgingival sulcus and the interproximal areas between teeth to remove plaque and food debris. 1 Dental water jets are also commonly known as oral or dental irrigator, water flosser, or Waterpik
Mechanism of Action Pulsating action that incorporates a compression and decompression phase, causing the plaque biofilm and oral debris to become dislodged. 2 The movement of the fluid (called the hydrokinetic activity) creates two distinct zones 1. Impact zone - Area of initial contact 2. Flushing zone - Depth of fluid penetration Hydrokinetic activity results in subgingival and interdental fluid penetration, and a greater potential for biofilm removal deep within the sulcus. 2
Correct Usage of Various Water Jet Tips
Effect of Dental Water Jet Studies conducted over the past 40 years have clinically proven a number of benefits of dental water jet use 2 Removal of biofilm Reduction in bleeding Reduction in gingival inflammation Reduction of periodontal pathogens Reduction of inflammatory mediators and destructive host response
Indications Dental water jets are indicated for almost ALL Clients who can benefit most: clients! - Clients with limited dexterity - Young clients, elderly clients, some clients with special needs - Clients with fixed orthodontic appliances - Clients with bridges - Clients with implants - Clients with diabetes - Clients with periodontal disease
Orthodontics Study: Single blind, parallel clinical study 3 Conclusion: Dental water jet reduces plaque and bleeding in clients with fixed orthodontic appliances 106 subjects randomly assigned to 1 of 3 treatment groups: (1) 1x daily use of water jet plus a manual toothbrush; (2) 1x daily flossing plus a manual toothbrush (3) manual toothbrush (MT) only DWJ was statistically more effective at reducing whole-mouth and interproximal plaque (P >.001) at both 2 and 4 weeks Statistically more effective at reducing whole-mouth bleeding than the protocols of the other groups at 2 and 4 weeks (P <.001)
Implants Study: 30-day randomized clinical trial 4 Efficacy of water flossers vs. string floss (both paired w/mtb) in reducing BOP around implants 2 Groups: (1) unflavored waxed string floss (2) water flosser Checked at day 14 and day 30 Conclusion: Water flosser paired w/mtb is more effective at reducing bleeding around implants than string floss
Implants with Peri-implantitis Study: Prospective randomized interventional cohort study was conducted on 40 consecutive patients presenting with peri-implantitis. 5 Effect of a dental water jet containing chlorhexidine on clinical signs of peri-implantitis 2 groups : (1) water jet device containing chlorhexidine gel for home use twice daily (2) recommended oral hygiene measures with no water jet Group 1 showed greater mean probing depth reduction (0.75 mm vs 0.27 mm; P =.029) as well as greater reduction in the number of sites presenting with bleeding on probing (2.26 vs 0.45 sites; P =.011). Conclusion: Water jet mixed with chlorhexidine gel may supplement the response to nonsurgical treatment for peri-implantitis lesions.
Contraindications Clients who lack the ability to expectorate. 1 Clients at high risk of infective endocarditis should consult their physician before using a dental water jet. 2
Water Jet and Pocket Depths - Water jets have the ability to reach deeper into periodontal pockets than a toothbrush, interdental aid, or rinsing. 1 - Allowing: better subgingival cleaning, deeper delivery of antimicrobial agents. - Depth to which solution reaches depends on the tip used. 1 - Standard jet tip: has been shown to reach - 71% in pockets 0 to 3 mm - 44% in pockets 4 to 7 mm - 68% in pockets 7+ mm. - Specialty tips: (placed slightly below gingival margin) deliver solution up to - 90% in pockets 6mm deep - 64% in pockets 7+mm
Plaque Biofilm Removal with a Dental Water Jet This study evaluated the effect of a Waterpik dental water jet on plaque biofilm removal on 8 extracted teeth with advanced aggressive periodontal disease. Results were measured using scanning electron microscopy (SEM) 6 Results: The Waterpik dental water jet (on medium pressure for 3 seconds) removed biofilm significantly. 6 Standard tip removed 99.99% of plaque biofilm Orthodontic tip removed 99.84% of plaque biofilm
Water Jet vs Floss Study: Randomized, single-blind clinical trial. 7 Efficacy of the addition of daily oral irrigation to both power and manual tooth brushing, compared to a traditional regimen of manual tooth brushing and flossing 105 subjects randomly assigned to one of three groups (1) manual toothbrush and floss (2) manual toothbrush and dental water jet (3) sonic toothbrush and dental water jet Conclusion: Water irrigator used with a manual or sonic toothbrush is more effective than floss at reducing bleeding, gingival inflammation, and plaque.
Dental Water Jet Attachment Tips
Powered Tongue Cleaner Attachments - Provides a flushing action, removing plaque and debris from the dorsum of the tongue - Can be used to deliver an antimicrobial - Can help control or eliminate malodor - May help clients who have difficulty with dexterity - To date no data shows these devices are more efficient than a manual tongue cleaner. 1
Models and Price Range Waterpik $70 Drugstore $19 Nicefeel $30 Kingstar $17 Waterpik $45 Waterpik $100 Waterpik $60
Shower and Sink Water Flossers ShowerBreeze and other shower flossers $20 - $40 Sink attached dental water jets $16-20
Patient Education Video
Quick Review: How to Use a Water Jet 1. Fill the reservoir with lukewarm water and/or an antimicrobial agent 2. Select the appropriate tip 3. Run water line for 10 seconds
Quick Review: How to Use a Water Jet 4. Leaning over the sink, place water jet tip into the mouth THEN turn on 5. Adjust the pressure setting 6. Aim the tip of the water jet at a 90 degree angle to the long axis of the tooth (when using a standard tip)
Quick Review: How to Use a Water Jet 7. Use water jet tip to trace the gingival margin of each tooth - Start in the posterior and work towards the anterior 8. Pause at each interproximal space for a few seconds before continuing onto the next tooth - Recommended duration 1-8-10 seconds (posteriors) - 4-6 seconds (anteriors) 9. Repeat until all tooth surfaces have been covered
References 1. Darby M, Walsh M. Dental Hygiene: Theory and Practice 4 th Edition. Bowen DM, editor. St Louis, MO: Elsevier, 2015. p. 417 8. 2. Gehrig JS, Willmann DE. Foundations of Periodontics for the Dental Hygienist. 3rd Edition. Philadelphia: Lippincott Williams & Wilkins; 2011.p. 450-459. 3. Sharma, N. Lyle, D. Qaqish, J. Galustians, J. and Schuller, R. Effect of a dental water jet with orthodontic tip on plaque and bleeding in adolescent patients with fixed orthodontic appliances. Am J Orthod Dentofacial Orthop. [Internet]. 2008 April [cited 2017 March 5];133(4):565 571. Available from: www.ajodo.org/article/s0889-5406(07)01349-2 4. Magnuson B, Harsono M, Stark PC, Lyle D, Kugel G, Perry R. Comparison of the effect of two interdental cleaning devices around implants on the reduction of bleeding: a 30-day randomized clinical trial. Compend Contin Educ Dent [Internet]. 2013 [cited 2017 February 10];2 7. Available from: http://library.foothill.edu:2208/ehost/pdfviewer/pdfviewer?vid=1&sid=4acc9d43-cd6e-4f1b-b793-1a1a965dc80c@sessionmgr2 5. Levin, L, Frankenthal, S, Joseph, L, Rozitsky, D, Levi, G, Machei, E. Water jet with adjunct chlorhexidine gel for nonsurgical treatment of peri-implantitis. Quintessence Int [Internet] 2015 Feb. [Cited 2017 February 10]; 46(2):133-7. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25262677 6. Gorur, A, Lyle, D, Schaudinn, C, Costerton, J. Biofilm removal with a dental water jet. Compend Contin Educ Dent. [Internet]. 2009 March [cited 2017 March 5]; 30(1): 1-6. Available from http://library.foothill.edu:2209/ehost/pdfviewer/pdfviewer?sid=01a1d7dd-5c5a-4a64-9b6e-00c439ded3af%40sessionmgr4006&vid=4&hid=4201 7. Barnes, C, Russell, C, Reinhardt, R, Payne, J, Lyle, D. Comparison of irrigation to floss as an adjunct to tooth brushing: effect on bleeding, gingivitis, and supragingival plaque. J Clin Dent. [Internet] April 2005. [cited 2017 February 20];16(3):71-7. Available from: w.dewittetandenwinkel.nl/docs/research/jocd/jocd_wp.pdf (Images from Google Images and references listed above)
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